A. PMS involves an assortment of disabling physical and emotional symptoms that appear during the luteal phase and resolve within the first week of the follicular phase. Symptoms of PMS fall into four main categories: mood, somatic, cognitive, and behavioral.
B. No specific serum marker can be used to confirm the diagnosis. Premenstrual dysphoric disorder is diagnosed when mood symptoms predominate symptoms of PMS.
C. The differential diagnosis includes hypothyroidism, anemia, perimenopause, drug and alcohol abuse, and affective disorders. Common alternative diagnoses in patients complaining of PMS include affective or personality disorder, menopausal symptoms, eating disorder, and alcohol or other substance abuse. A medical condition such as diabetes or hypothyroidism, is the cause of the symptoms in 8.4%, and 10.6% have symptoms related to oral contraceptive (OC) use.
D. Affective symptoms of PMS strongly resemble major depression, except that PDD differs from major depression in that PDD occurs in the premenstrual phase alone. Selective serotonin reuptake inhibitors have been shown to be effective in the treatment of premenstrual dysphoria.
E. PMS is associated only with ovulatory menstrual cycles. While symptoms may occur with nonovulatory cycles, such as during therapy with oral contraceptives, the symptoms are believed to be hormonally related, because changing the contraceptive formulation usually alters the symptom pattern.
F. Nutrient abnormalities. Deficiencies of magnesium, manganese, B vitamins, vitamin E and linoleic acid and its metabolites have been reported in women with PMS. In addition, dietary deficiencies of calcium, magnesium and manganese have been described in women with menstrually related discomforts.
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